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    Pittsburgh Knee Rules

    Defines when knee x-rays are unnecessary, based on the Pittsburgh rules.
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    When to Use
    Pearls/Pitfalls
    Why Use

    The Pittsburgh decision rules can be applied to all patients with an acute knee injury in the past 1 week old, without prior knee surgery or ED evaluation.

    • The Pittsburgh knee rules were derived to aid in the efficient use of radiography in acute knee injuries.
    • Found in most studies to have a higher specificity than the Ottawa Knee Rule, which would mean fewer x-rays would be needed, while maintaining a sensitivity close to 100%.
    • Not useful in children under age 12 as all these patients would require x-rays by the Pittsburgh decision rules.
    • The Pittsburgh decision rules are not as well validated as the Ottawa Knee Rule with fewer external validation studies.
    • Patients without criteria for imaging by the Pittsburgh decision rules are highly unlikely to have a fracture and do not need plain radiographs.
    • It has a higher specificity than the Ottawa Knee Rule, reducing the number of false positives.
    • Application of the Pittsburgh decision rules can cut down on the number of unnecessary radiographs by up to 78%.
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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Patients who do not meet the Pittsburgh decision rules do not need an x-ray. If one of the conditions are met, then x-ray is recommended.

    Management

    For significant non-bony injuries, often crutches and a knee immobilizer can be helpful to assist with ambulation.

    Critical Actions

    Patients who do not meet the Pittsburgh decision rules do not need an x-ray. If one of the conditions are met, then x-ray is recommended.

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    About the Creator
    David Seaberg, MD
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